Remote RN: Utilization Management Specialist

CVS Health Corporation

United States

Remote

USD 44,000 - 95,000

Full time

12 days ago

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Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation is seeking an experienced Registered Nurse in Utilization Management to work remotely, with a preference for candidates in Central or Eastern Time Zones. You will review clinical information, apply guidelines, and support coverage determinations and care recommendations.

In this 24/7 operation, you will collaborate with providers and interdisciplinary teams, identify opportunities for care management, and promote high‑quality, member‑centered care while complying with

Qualifications

Active, unrestricted RN license in your state of residence.
2+ years of RN experience in adult acute care or critical care settings.
Strong communication, critical thinking, and multitasking skills.
Proficiency navigating multiple computer systems in a high-volume environment.

Responsibilities

Review and assess clinical information to support coverage determinations and care recommendations.
Apply clinical guidelines, policies, and professional judgment to utilization management decisions.
Collaborate with providers and interdisciplinary teams to coordinate care and treatment plans.
Identify opportunities for care management referrals and enhanced member support services.
Promote quality outcomes, effective healthcare utilization, and member-centered care.
Serve as a clinical resource for internal and external stakeholders.